Usefulness of two-dimensional echocardiography for immediate detection of myocardial ischemia in the emergency room

doi:10.1016/0002-9149(90)90143-O

The American Journal of Cardiology

Volume 65, Issue 11, 15 March 1990, Pages 687-691

https://doi.org/10.1016/0002-9149(90)90143-O Get rights and content

Abstract

Inappropriate discharge from the emergency room of patients with acute chest pain may have serious consequences. Regional asynergy is one of the first signs of myocardial ischemia and can be detected with 2-dimensional echocardiography (2-DE). This study determines the value of 2-DE in the emergency room for immediate detection of myocardial ischemia causing acute chest pain at the time the electrocardiogram was nondiagnostic. Forty-three patients (32 men and 11 women) with a normal or nondiagnostic electrocardiogram during acute chest pain were studied with 2-DE. Only patients without a previous myocardial infarction and without known coronary artery disease (CAD) were studied. The entire left ventricular wall was examined for presence of regional asynergy. Coronary angiography was performed within 3 weeks. Cardiac enzyme levels were measured serially to establish or rule out an acute myocardial infarction. Sensitivity of 2-DE for detection of myocardial ischemia was 88% (22 of 25), specificity 78% (14 of 18), negative predictive accuracy 82% (14 of 17) and positive predictive accuracy 85% (22 of 26). Sensitivity of 2-DE for detection of acute myocardial infarction was 92% (12 of 13), specificity 53% (16 of 30) and negative predictive accuracy 94% (16 of 17). Thus, 2-DE during pain and a nondiagnostic electrocardiogram can readily identify patients with CAD in the emergency room, and it can accurately rule out an acute myocardial infarction.

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Citation Excerpt :
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2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force
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Usefulness of two-dimensional echocardiography for immediate detection of myocardial ischemia in the emergency room

Abstract

Am J Cardiol

Am J Cardiol

Am J Med

Am Heart J

JACC

Am J Cardiol

Am J Cardiol

Chest

Am J Cardiol

JACC

Disposition of presumed coronary patients from an emergency room, a follow-up study

JAMA